Expectorant ipecac

Mucous airway obstruction. Mu-colytics, such as acetylcysteine, split disulfide bonds in mucus, hence reduce its viscosity and promote clearing of bronchial mucus. Other expectorants (e.g., hot beverages, potassium iodide, and ipecac) stimulate production of watery mucus. Acetylcysteine is indicated in cystic fibrosis patients and inhaled as an aerosol. Whether mucolytics are indicated in the common cold and whether expectorants like bromohexine or am-broxole effectively lower viscosity of bronchial secretions may be questioned. 

Ipecac is the root of Cephaetis ipecacuanha, or of C. acuminata, a perennial shrub growing in Brazil and other South American states (Figure 44.1). It contains three alkaloids — emetin, cephaelin, and psychotrin. The dose of the powdered drug as an expectorant is from 1/2 to 2 grain (0.03 to 0.13 g) as an emetic, 15 to 30 grain (1.0 to 2.0 g) (Table 44.1). 

Emetics, when administered in small doses, act as expectorants and are used in inflammatory conditions of the respiratory tract to increase the bronchial secretion and render it less tenacious. The most commonly used expectorants are ipecac, ammonium chloride, and apomorphine. The last named is administered in doses of 1 mg in the form of an elixir or syrup. Apomorphine injected in subemetic doses of 1 to 2 mg is also used as a sedative in the delirium following anesthesia, in acute alcoholic psychosis, and in patients manifesting severe agitation prior to anesthesia. 

Ext. Ipecacuanhs (extract of ipecac) A powerful emetic. In smaller doses, it was used as a diaphoretic and expectorant. 

The root of the ipecac is commonly used as an expectorant in the treatment of bronchitis, croup, asthma amoebacide and whooping cough, as an emetic in cases of poisoning, and an amoebacide in amoebic dysentery. It has appeared in the Japanese Pharmacopoeia (2001) as ipecac, powdered ipecac and ipecac S)nxip [6]. The ipecac is rich in isoquinoline alkaloids such as emetine, cephaeline, psychotrine. 

Emetine (Fig. 7-9) in the form of the crude drug obtained from the roots and rhizomes of Ipecac (Cephaelis ipecacuanha) has been in use since the seventeenth century. The alkaloid, as the hydrochloride, has been used parenterally to treat amebic dysentery. It is also effective in hepatic infestation, but not against amebic cysts. Because of its cardiac toxicity and emetogenic properties, it has been superseded by metronidazole and chloroquine, but it is still used as an alternative. The amebicidal mechanism of emetine is protein synthesis inhibition by interference of peptidyl-RNA translocation. Since this action is general to eukaryotic cells, its relative selectivity in the presence of mammalian cells is not well understood. Unrelated uses of Ipecac (presumably due to its alkaloid content) are as an expectorant in cough preparations and an emergency emetic (Syrup of Ipecac). 

O-methylpsychotrine, and emetamine [7], Fig. (2), emetine and cephaeline being the principal active ingredients. Emetine having a more expectorant and less emetic action than cephaeline is the most commonly used alkaloid in medicine [8], Emetine hydrochloride is used in the treatment of amoebic dysentery by injection. Strong emetic action of the alkaloids characterizes an ipecac syrup that is the first choice of drug in the case of infant intoxication [9]. 

Z ) Nauseant Expectorants These act as expectorants in small doses and nauseant and emetic in large doses, e.g., tartar emetic, ipecac, etc. These are usually mixed with sweet-tasting cough syrups that help to cure croupous bronchitis in children. 

Ipecac root has been used in therapy since the beginning of the XVIIth century as an emetic and expectorant its use against dysentery, already recommended by Helvetius in the eighteenth century, was found to be therapeutically correct in 1912, when emetine, the most important of its alkaloids, was successfully used by L. Rogers (80) in the treatment of amebic dysentery. This very important application has stimulated many investigations of Ipecac root and has shown emetine to be an almost indispensable alkaloid. 

Ipecac alkaloids are derived from the amino acid tyrosine and the monoterpene secologanin and are therefore termed terpenoid-isoquinoline alkaloids. They occur in the eudicot families Alangiaceae and Rubiaceae. Two species, Psychotria ipecacuanha (Rubiaceae) and Alangium lamarckii (Alangiaceae), have been investigated in detail with respect to their metabolites and biosynthesis of their alkaloids (Fujii and Ohba, 1998). Roots and rhizomes of P. ipecacuanha are the source of cephaeline and emetine (Fig. 9), two compounds with emetic, expectorant, and amebicidal properties. 

Cocillana is reported to have expectorant and, in higher doses (1.3-3.0 g), emetic properties similar to those of ipecac (bradly list and horhammer). These properties are based on findings reported at the end of the last century. No recent pharmacological or toxicological data on cocillana are available. 

Ipecac has emetic properties, acting both centrally (possibly through the involvement of a 5-HT4 receptor) and loeally to cause vomiting. Emetic action starts to fade after 30 min from administration. In small doses it has diaphoretic, expectorant, andstimulantproperties (usd 26th). Ipecac also reduces absorption of ingested substances in a time-dependent fashion. This effect becomes insignificant after ca. 90 min from administration of ipecac syrup. ... 

Rubiaceae, such as Cephaelis acuminata, Cephalis ipecacuanha, or Cephaelis accuminata. Ipecac alkaloids have powerful emetic and expectorant properties as well as anti-amoebic and antitumor activity, and some of them are widely used to treat amoebic dysentery (e.g., emetine and tubulosine), as well as schistosomiasis, leishmaniasis, and malaria (e.g., emetine). Isoquinoline alkaloid crispine A exhibits cytotoxic activity against SKOV3, KB, and HeLa human cancer lines and was isolated from C. crispus by Zhao et al. ... 

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